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    v1.0.30
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j1305-evinacumab-injection-5mg
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    HCPCS Level II J1305: Evinacumab-dgnb Injection, 5 mg

    HCPCS Level II code J1305 describes the drug injection evinacumab-dgnb, 5 mg for intravenous administration, representing a biologic specialty medication delivered as an injection or infusion in outpatient infusion centers, hospital outpatient departments, or other ambulatory care settings where parenteral biologic therapies are provided.

    For related coverage guidance, see recent payer policy updates: T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Tumor Treatment Fields - Medical Policy, Extracorporeal Photopheresis.

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    Clinical & Coding Specifications

    Clinical Context

    A patient with homozygous familial hypercholesterolemia (HoFH) or severe refractory hypercholesterolemia attends a specialty infusion clinic for administration of a monoclonal antibody therapy, J1305 (evinacumab-dgnb, 5 mg). The typical patient is an adult or adolescent referred by a cardiologist, lipid specialist, or endocrinologist after inadequate response to maximally tolerated lipid-lowering therapies (statins, ezetimibe, PCSK9 inhibitors) and when LDL-C remains markedly elevated. Prior to the visit, baseline labs including lipid panel, liver function tests, and pregnancy testing (if applicable) are reviewed. The patient is screened for active infections and infusion contraindications.

    On arrival, nursing performs an intake assessment, documents vitals and allergy history, and obtains informed consent for infusion. An intravenous catheter or appropriate peripheral access is prepared if the product is administered IV (based on product instructions). The infusion or injection is prepared by pharmacy per institutional protocol and administered by an RN or qualified infusion nurse. The patient is observed during and after the injection for immediate reactions; emergency medications and resuscitation equipment are available. Post-administration documentation includes lot number, NDC/HCPCS J1305 units administered, site of administration, and any patient response or adverse events.

    Typical site of service: outpatient infusion clinic, specialty ambulatory infusion center, or hospital outpatient department. Service type: specialty drug injection/infusion therapy for lipid-lowering management in patients with severe familial or refractory hypercholesterolemia.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96365Intravenous infusion, initial, for therapy, prophylaxis, or diagnosis; up to 1 hourUsed when an initial therapeutic infusion visit is performed for administration of a biologic if the route and infusion duration meet requirements.
    96366Intravenous infusion, each additional hour (use with 96365)Used when infusion of the biologic extends beyond the initial hour.
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularUsed when J1305 is administered as a subcutaneous or intramuscular injection per product/clinic protocol.
    36415Collection of venous blood by venipunctureOften performed before or during the visit for baseline or follow-up laboratory monitoring (lipid panel, liver enzymes).
    99213Office or other outpatient visit, established patient, low to moderate complexityCommon evaluation and management visit for follow-up relating to infusion management and assessment of response.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2080P0207X
    207RC0000X
    363L00000X
    163W00000X
    174400000X
    261QX0203X
    2080P0210X
    385HR2050X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    E03.8Other specified hypothyroidism
    E03.9Hypothyroidism, unspecified
    E10.65Type 1 diabetes mellitus with hyperglycemia
    E11.51Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
    E11.59Type 2 diabetes mellitus with other circulatory complications
    E66.01Morbid (severe) obesity due to excess calories
    E66.9Obesity, unspecified
    E78.00Pure hypercholesterolemia, unspecified
    E78.1Pure hyperglyceridemia
    E78.2Mixed hyperlipidemia

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and RomidepsinMass General Brigham Health Plan2027-01-04
    Tumor Treatment Fields - Medical PolicyHealth-New-England2026-12-01
    Extracorporeal PhotopheresisCigna2026-11-15
    Electric Tumor Treatment Field Therapy (for Tennessee Only)Colorado Rocky Mountain Health Plans2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    Tumor Treating Fields Therapypremerabluecrossofwashington2026-11-01
    OmisirgeCigna2026-11-01
    Hematology - AdzynmaCigna2026-10-15
    Transcatheter Arterial Chemoembolization for Liver Tumorspremerabluecrossofwashington2026-10-01
    Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bonepremerabluecrossofwashington2026-10-01

    Related Codes

    HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

    HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

    HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

    HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

    HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

    HCPCS Level II J0121: Omadacycline Injection, 1 mg

    HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

    HCPCS Level II J0122: Injection, eravacycline, 1 mg

    HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

    HCPCS Level II J0129: Abatacept Injection, 10 mg

    HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

    HCPCS Level II J0130: Injection abciximab, 10 mg

    HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

    HCPCS Level II J0131: Injection, Acetaminophen 10 mg

    HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

    HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

    HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

    HCPCS Level II J0133: Injection, Acyclovir 5 mg

    HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

    HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

    Showing 1–10 of 991

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    99070
    Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit
    Used to bill separately for supplies associated with infusion when applicable.